Browsing by Author "Moono, Misinzo"

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Accuracy of screening tests for cervical precancer in women living with HIV in low-resource settings: a paired prospective study in Lusaka, Zambia.
(2024) Taghavi, Katayoun; Moono, Misinzo; Mwanahamuntu, Mulindi; Roumet, Marie; Limacher, Andreas; Kapesa, Herbert; Madliwa, Thamsanqa; Rutjes, Anne; Basu, Partha; Low, Nicola; Manasyan, Albert; Bohlius, Julia
OBJECTIVE: This study aimed to provide evidence to improve cervical screening for women living with HIV (WLHIV). We assessed the accuracy of screening tests that can be used in low-resource settings and give results at the same visit. METHODS AND ANALYSIS: We conducted a paired, prospective study among consecutive eligible WLHIV, aged 18-65 years, receiving cervical cancer screening at one hospital in Lusaka, Zambia. The histopathological reference standard was multiple biopsies taken at two time points. The target condition was cervical intraepithelial neoplasia grade 2 and above (CIN2+). The index tests were high-risk human papillomavirus detection (hrHPV, Xpert HPV, Cepheid), portable colposcopy (Gynocular, Gynius) and visual inspection with acetic acid (VIA). Accuracy of stand-alone and test combinations were calculated as the point estimate with 95% CIs. A sensitivity analysis considered disease when only visible lesions were biopsied. RESULTS: Women included in the study had well-controlled HIV infection (median CD4 count=542 cells/mm CONCLUSION: The low accuracy of screening tests assessed might be explained by our reference standard, which reduced verification and misclassification biases. Better screening strategies for WLHIV in low-resource settings are urgently needed. TRIAL REGISTRATION NUMBER: NCT03931083.
Cervical intraepithelial neoplasia progression and regression among women living with HIV in Zambia
(2025-10-16) Andoh, John; Taghavi, Katayoun; Moono, Misinzo; Basu, Partha; Madliwa, Thamsanqa; Mwanahamuntu, Mulindi H.; Low, Nicola; Manasyan, Albert; Rohner, Eliane
Abstract Objectives: Cervical screening and precancer treatment are less effective in women living with HIV (WLWH) than in women without HIV. We assessed high-risk human papillomavirus (HR-HPV) infection and cervical disease progression among screened WLWH in Zambia. Methods: Participants underwent visual inspection with acetic acid (VIA), HR-HPV testing and cervical biopsies at baseline and at follow-up 30-36 months later. Women with positive VIA results or high-grade histology were offered treatment. We assessed HR-HPV and cervical disease prevalence at both timepoints and used multivariable logistic regression to identify factors associated with cervical disease progression and regression. Results: Among 241 included women, HR-HPV prevalence declined from 44% (95% confidence interval [CI]: 39%-49%) at baseline to 24% (95% CI: 19%-31%) at follow-up. High-grade disease decreased from 25% (95% CI: 20%-31%) to 9% (95% CI: 5%-13%). In analyses adjusted for age, CD4 cell count, HIV RNA viral load, HR-HPV infection and histological results at baseline, precancer treatment was associated with increased odds of disease regression (adjusted odds ratio [aOR]: 2.74, 95% CI: 1.08-7.06) and reduced odds of progression (aOR: 0.45, 95% CI: 0.11-1.64). One-third of women with high-grade disease at follow-up (7/21) had previously undergone precancer treatment. Conclusions: Cervical screening and precancer treatment are key to reducing cervical disease progression among WLWH and ultimately achieving cervical cancer elimination, but efforts to improve treatment effectiveness among WLWH must be balanced with the risk of overtreatment.
Estimating potential silent transfer using baseline viral load measures among people presenting as new to HIV care in Lusaka, Zambia: a cross-sectional study.
(2023-May-25) Pry, Jake M.; Mwila, Chilambwe ; Kapesa, Herbert; Mulabe, Musunge; Frimpong, Christiana ; Moono, Misinzo; Savory, Theodora; Bolton-Moore, Carolyn; Herce, Michael E.; Iyer, Shilpa
OBJECTIVES: To estimate potential silent transfer using baseline viral load measures among individuals presenting as new to HIV care in routine HIV clinical settings in Lusaka, Zambia. DESIGN: Cross-sectional study. SETTING: Two large, urban government-operated health facilities supported by the Centre for Infectious Disease Research in Zambia. PARTICIPANTS: A total of 248 participants with an incident positive HIV rapid test. OUTCOME MEASURES: The primary outcome measure was HIV viral suppression at baseline (i.e., potential silent transfer), defined as having a viral load ≤1000 RNA copies(c)/mL at the time of initiating HIV care. We also examined viral suppression at ≤60 c/mL. METHODS: We surveyed and measured baseline HIV viral load as part of the national recent infection testing algorithm among people living with HIV (PLWH) presenting as new to care. Using mixed effects Poisson regression, we identified characteristics among PLWH associated with potential silent transfer. RESULTS: Among the 248 PLWH included, 63% were women with median age of 30, and 66 (27% (66/248)) had viral suppression at ≤1000 c/mL and 53 (21% (53/248)) at ≤60 c/mL thresholds, respectively. Participants aged 40+ years had a significantly higher adjusted prevalence of potential silent transfer (adjusted prevalence ratio (aPR): 2.10; 95% CI: 2.08, 2.13) compared with participants aged 18-24 years. Participants reporting no formal education had a significantly higher adjusted prevalence of potential silent transfer (aPR: 1.63; 95% CI: 1.52, 1.75) compared with those completing primary education. Among 57 potential silent transfers who completed a survey, 44 (77%) indicated having tested positive previously at ≥1 of 38 clinics in Zambia. CONCLUSIONS: The high proportion of PLWH with potential silent transfer points to clinic shopping and/or co-enrolment at multiple care sites simultaneously, suggesting an opportunity to improve care continuity at the time of HIV care entry.
Genotype-specific agreement and accuracy of human papillomavirus DNA detection using AnyplexTM II HPV28 and XpertTM HPV among women with HIV in Lusaka, Zambia: a diagnostic accuracy analysis
(2026) Nathalie, Villalobos V. F; Moono, Misinzo; Andoh, John; Glass, Allison; Basu, Partha; Madliwa, Thamsanga; Mwanahamuntu, Mulindi; Rohner, Eliane; Low, Nicola; Manasyan, Albert; Taghavi, Katayoun
Abstract Objectives: The prevalence of cervicovaginal high-risk human papillomavirus (hrHPV) is high among women with human immunodeficiency virus (WHIV). Many hrHPV tests exist, but genotype-specific comparisons among WHIV are limited. We compared hrHPV detection and diagnostic accuracy using AnyplexTM II HPV 28 and XpertTM HPV among WHIV in Lusaka, Zambia. Methods: WHIV enrolled in a cervical screening test accuracy study (05/2019-03/2021) were invited for rescreening after 36 months. Trained nurses collected the cervical cytology and biopsy samples. Cytology samples were tested using Anyplex and Xpert. Women with paired and valid hrHPV results were included. We compared hrHPV and genotype-specific prevalence, overall agreement, Cohen kappa (κ), and relative sensitivity and specificity for the detection of high-grade squamous intraepithelial lesions (HSIL). Results: Among 230 women seen between 05/2022 and 06/2023, hrHPV prevalence was 24% (55/230) using Xpert and 36% (82/230) using Anyplex. Detection of HPV16 was higher with Anyplex (9%, 20/230) than with Xpert (6%, 13/230). Overall agreement was 85% (κ = 0.64; 95% confidence interval [CI] = 0.53-0.74). Genotype-specific agreement ranged from 88% (other hrHPV, κ = 0.66) to 96% (HPV16, κ = 0.70). For the detection of HSIL, the relative sensitivity of Anyplex compared with Xpert was 1.07 (95% CI = 0.94-1.21), and the relative specificity was 0.85 (95% CI = 0.79-0.91). Conclusion: Agreement between Anyplex and Xpert for hrHPV detection was high, but genotype-specific detection differed, with Anyplex detecting HPV16 more frequently than Xpert. While both assays had similar sensitivity, Xpert was more specific for HSIL. The choice of assay should balance the goals of maximizing HSIL detection with minimizing overtreatment.
Home deliveries in the capital: a qualitative exploration of barriers to institutional deliveries in peri-urban areas of Lusaka, Zambia.
(2018-Jun-01) Mulenga, Tamara; Moono, Misinzo; Mwendafilumba, Martha; Manasyan, Albert; Sharma, Anjali
BACKGROUND: A shortage of skilled birth attendants and low quality of care in health facilities along with unattended home deliveries contribute to the high maternal and neonatal mortality in sub Saharan Africa. Identifying and addressing context-specific reasons for not delivering at health care facilities could increase births assisted by skilled attendants who, if required, can provide life-saving interventions. METHODS: We conducted 22 in-depth interviews (IDIs) with midwives at three health facilities in peri-urban communities and 24 semi-structured surveys with mothers in two areas served by health facilities with the highest number of reported home deliveries in Lusaka, Zambia. Both IDIs and surveys were audio-recorded, transcribed and coded to identify themes around delivery and birthing experience. RESULTS: We found that most women preferred institutional deliveries to home deliveries, but were unable to utilize these services due to inability to recognize labour symptoms or lack of resources. Midwives speculated that women used herbal concoctions to reduce the duration of delivery with the result that women either did not present in time or endangered themselves and the baby with powerful contractions and precipitous labour. Respondents suggested that disrespectful and abusive maternity care dissuaded some women from delivering at health facilities. However, some midwives viewed such tactics as necessary to ensure women followed instructions and successfully delivered live babies. CONCLUSION: Difference in beliefs and birthing practices between midwives and mothers suggest the need for open dialogue to co-design appropriate interventions to increase facility usage. Further examination of the pharmaceutical properties and safety of herbal concoctions being used to shorten labour are required. Measures to reduce the economic burden of care seeking within this environment, increase respectful and patient-centred care, and improve the quality of midwifery could increase institutional deliveries.
Human papillomavirus detection in liquid-based cytology and cervical histology samples among women living with human immunodeficiency virus in Zambia
(2026-08-11) Taghavi, Katayoun; Moono, Misinzo; Villalobos, Nathalie V. F.; Andoh, John; Glass, Allison; Basu, Partha; Madliwa, Thamsanqa; Mwanahamuntu, Mulindi H.; Manasyan, Albert; Rohner, Eliane
Abstract Objectives: Cervicovaginal human papillomavirus (HPV) prevalence is high among women living with human immunodeficiency virus (WLHIV), but not all HPV genotypes detected in liquid-based cytology (LBC) may be present in cervical tissue. We explored HPV genotype concordance in paired LBC and histology samples among WLHIV in Zambia. Methods: WLHIV aged 18-65 years who were enrolled in a cervical screening test accuracy study were invited for follow-up after 30-36 months. LBC samples and two or more cervical biopsies were collected and tested for 28 HPV genotypes (Anyplex II/Allplex HPV28, Seegene, South Korea). HPV prevalence and genotype-specific agreement were assessed using Cohen's kappa. Results: From April 2022 to May 2023, 242 WLHIV (22 with high-grade squamous intraepithelial lesions) had valid paired HPV results. The prevalence of any HPV was similar on LBC (39%) and histology (34%). Multiple-type infections were more common on LBC (18%) than on histology (10%). HPV 16 was the most frequent genotype: 9% (n = 22) on LBC, and 15% (n = 36) on histology. Agreement for any high-risk HPV genotype was 66.1% (kappa = 0.27). Conclusions: Among Zambian WLHIV with mostly low-grade cervical lesions, LBC showed more multiple-type HPV infections and limited agreement with histology samples, possibly reflecting transient infections detected by LBC. The frequent detection of HPV 16 in histology samples but not in LBC warrants further investigation.
Screening test accuracy to improve detection of precancerous lesions of the cervix in women living with HIV: a study protocol.
(2020-Dec-18) Taghavi, Katayoun; Moono, Misinzo; Mwanahamuntu, Mulindi; Basu, Partha; Limacher, Andreas; Tembo, Taniya; Kapesa, Herbert; Hamusonde, Kalongo; Asangbeh, Serra; Sznitman, Raphael; Low, Nicola; Manasyan, Albert; Bohlius, Julia
INTRODUCTION: The simplest and cheapest method for cervical cancer screening is visual inspection after application of acetic acid (VIA). However, this method has limitations for correctly identifying precancerous cervical lesions (sensitivity) and women free from these lesions (specificity). We will assess alternative screening methods that could improve sensitivity and specificity in women living with humanimmunodeficiency virus (WLHIV) in Southern Africa. METHODS AND ANALYSIS: We will conduct a paired, prospective, screening test accuracy study among consecutive, eligible women aged 18-65 years receiving treatment for HIV/AIDS at Kanyama Hospital, Lusaka, Zambia. We will assess a portable magnification device (Gynocular, Gynius Plus AB, Sweden) based on the Swede score assessment of the cervix, test for high-risk subtypes of human papillomavirus (HR-HPV, GeneXpert, Cepheid, USA) and VIA. All study participants will receive all three tests and the reference standard at baseline and at six-month follow-up. The reference standard is histological assessment of two to four biopsies of the transformation zone. The primary histological endpoint is cervical intraepithelial neoplasia grade two and above (CIN2+). Women who are VIA-positive or have histologically confirmed CIN2+ lesions will be treated as per national guidelines. We plan to enrol 450 women. Primary outcome measures for test accuracy include sensitivity and specificity of each stand-alone test. In the secondary analyses, we will evaluate the combination of tests. Pre-planned additional studies include use of cervigrams to test an automated visual assessment tool using image pattern recognition, cost-analysis and associations with trichomoniasis. ETHICS AND DISSEMINATION: Ethical approval was obtained from the University of Zambia Biomedical Research Ethics Committee, Zambian National Health Regulatory Authority, Zambia Medicines Regulatory Authority, Swissethics and the International Agency for Research on Cancer Ethics Committee. Results of the study will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT03931083; Pre-results.
The cervical cancer screening and precancer treatment journey: a qualitative study of experiences among Zambian women living with and without HIV
(2025-12-13) Moono, Misinzo; Sharma, Anjali; Bohlius, Julia; Mwanahamuntu, Mulindi; Taghavi, Katayoun; Mwamba, Chanda; Katota, Ntenje; Mwamba, Kabwe; Chipungu, Mwati; Hamweemba, Esther; Manasyan, Albert
Abstract Background: Zambia has the third highest cervical cancer incidence rate globally, and it remains the leading cause of cancer-related death among women. We explored the experiences of Zambian women who accessed cervical cancer screening and precancer treatment services to understand factors influencing care-seeking and access across urban, peri-urban, and rural settings. Methods: In 2020, we conducted eight focus group discussions with women living with and without Human Immunodeficiency Virus (HIV) who underwent cervical cancer screening between 2016 and 2020. To explore their care journey, participants were grouped by screening outcome—those with cervical precancerous lesions and those without. We also conducted 18 in-depth interviews with healthcare workers providing antiretroviral treatment, cervical cancer screening, or precancer treatment at government health facilities. Transcripts were coded and analyzed using thematic analysis. Results: Care-seeking unfolded across five stages: recognition of need to screen, hesitation and consultation, screening, result interpretation, and treatment. Women were generally knowledgeable about cervical cancer and sought screening promptly, though some delayed due to fear. Social networks and interactions with healthcare workers facilitated screening, while logistical and financial barriers, along with delays in histopathology services particularly in rural areas, hindered access to timely diagnosis and treatment. Conclusion: Improving cervical cancer screening and precancer treatment in Zambia requires addressing systemic inefficiencies by strengthening laboratory capacity, decentralizing diagnostics, and training healthcare workers to provide respectful, consistent counselling. Expanding community engagement to counter misinformation, leveraging social networks, and providing financial protection are also critical to ensuring timely, equitable, and reassuring care. DOI: 10.1093/oncolo/oyaf412